Quality statement 2: One-to-one care

Quality statement

Women in established labour have one-to-one care and support from an assigned midwife.

Rationale

One-to-one care will increase the likelihood of the woman having a 'normal' vaginal birth without interventions, and will contribute to reducing both the length of labour and the number of operative deliveries. Care will not necessarily be given by the same midwife for the whole labour.

Quality measures

Structure

Evidence of midwifery staff available to provide one-to-one care to women in established labour in each birth setting.

Data source: Local data collection.

Process

Midwifery staffing levels as in the NICE guideline on safe midwifery staffing for maternity settings.

Numerator – The number of women in the denominator who receive one-to-one care from an assigned midwife during established labour.

Denominator – The number of women in established labour in a time period.

Data source: Local data collection.

Outcome

a) Neonatal morbidity.

Data source: Local data collection.

b) Maternal morbidity.

Data source: Local data collection.

c) Maternal satisfaction and experience of care.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (for all 4 birth settings) ensure that recommended midwifery staffing ratios are maintained so that women in established labour have one-to-one care and support from an assigned midwife.

Healthcare professionals (assigned midwives) give one-to-one care to each woman in established labour and are solely dedicated to the care of that woman.

Commissioners (clinical commissioning groups) commission services that have systems in place to maintain recommended midwifery staffing ratios, so that women in established labour have one-to-one care and support from an assigned midwife. Commissioners can refer to the costing statement for the guideline on intrapartum care for healthy women and babies for more information about the likely resource impact of this quality statement, which will depend on local circumstances.

What the quality statement means for women and their companions

A woman in labour is cared for by a midwife who is looking after just her – this is called 'one-to-one care'. She might not have the same midwife for the whole of labour. One-to-one care aims to ensure that the woman has a good experience of care and reduces the likelihood of problems for her and her baby.

Source guidance

Definitions of terms used in this quality statement

Established labour

Labour is established when:

  • there are regular painful contractions and

  • there is progressive cervical dilatation from 4 cm.

[Intrapartum care for healthy women and babies (NICE guideline CG190) recommendation 1.3.1]